Sunday, July 23, 2017
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Human Resources

Annual Open Enrollment

Health Insurance

Health Insurance Enrollment Form
HSA Employee Contribution Authorization Form
Declaration of Domestic Partnership
Health Insurance Waiver Form
FY2018 Medical Dental Co-Shares Detail

  • Supplemental Required Documentation for family coverage:
    • Marriage license, if applicable
    • Birth certificates, if applicable
    • Declaration of domestic partnership, if applicable

 

Health Savings Account

(Eligible Police & Fire ONLY)
HSA Employee Contribution Authorization Form
HSA Additional Voluntary Contributions CY2017

 

Dental Insurance

Dental Insurance Enrollment Application
FY2018 Medical Dental Co-Share Detail

  • Supplemental Required Documentation for family coverage:
    • Marriage license, if applicable
    • Birth certificates, if applicable
    • Declaration of domestic partnership, if applicable

 

Supplemental Life Insurance

(Management and General Municipal employees ONLY) 
Supplemental Life Insurance Enrollment Form (General employees)
Supplemental Life Insurance Enrollment Form (Management)
Supplemental Life Insurance Rates

 

Short-Term Disability Insurance

(Eligible Police & Fire ONLY)
Short-Term Disability Enrollment Form
Dearborn National LTD & STD rates

 

Long-Term Disability Insurance

Short-Term Disability Enrollment Form
Dearborn National LTD & STD rates
 

457(b) Deferred Compensation

457(b) Enrollment Instructions
457(b) Deferred Compensation Deduction Authorization Form